250170 10/07/15 CITY OF CARMEL, INDIANA VENDOR: 367093
® ONE CIVIC SQUARE ALYSSA CLARK CHECK AMOUNT: $ ....""44.85"
CARMEL, INDIANA 46032 C/O PARKS CHECK NUMBER: 250170
CHECK DATE: 10/07/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 44.85 TRAVEL FEES & EXPENSE
I
GENERAL FORK IIG.101 11980
pWCAIBED BY STATE BOARD OF ACCOUNTS
i_ MILEAGE CLAIM
TO
((30VEANMENTAL mllT} ON ACCOUNT OF APPROPRIATION NO. FOR
(OiiTCP,BOARD,DEf AATb67R OA 7NSTIT17rION)
--- SPEEDOMETER AUTO MN-ESE
FROM TO READING + NATURE OF BUSSNE56 MILES a���, r
DATE START FINISH TRAVELED PER.MILE
L.r IS POINT POINT
- 3
-- MCC -----
1B I C1 MCC UE
C ---
ME
A�--
CC '
— C
C .
� — C
c
'C
.Z r C –
2Z
114
2
TOTALS
AUTO LICENSE NO.
+ SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155,Acts 1953;I hereby certify That the foregoing account is just and correct,that the amount claimed is legally due,after allowing all juet credits
and that no p�jr of the same has been paid. l
DateOCT
✓ !) ,
1
BY:
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
367093 Clark, Alyssa Terms
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
9/30/15 Reimb Mileage 8/19- 9/28/15 $ 44.85
Total $ 44.85
1 hereby certify that the attached invoice(s),or bill(s)is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
20_
Clerk-Treasurer
Voucher No. Warrant No.
367093 Clark,Alyssa Allowed 20
In Sum of$
$ 44.85
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or Board Members
Dept# INVOICE NO. CCT#/TITL AMOUNT
1081-4 Reimb 4343000 $ 44.85 1 hereby certify that the attached invoice(s), or
bill(s)is(are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
October 1, 2015
Signature
$ 44.85 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
s